Efficacy of Laser Therapy, Mechanical Scaling, and Scaling With Hand Instruments in Microbiological and Clinical Indices Alteration After Nonsurgical Periodontal Treatment: A Systematic Review and Network Meta-Analysis.

INTRODUCTION: The major role of chronic periodontal diseases in impairing human oral health shows the importance of seeking the most efficient implement to address this prevalent issue. The objective of this study is to compare nonsurgical treatment tools, including Gracey's curette, sonic/ultrasonic, and laser instruments, considering their effect on subgingival microbial flora and clinical indices. METHODS: Following a search in six databases, clinical studies using Gracey's curette, sonic/ultrasonic, or laser monotherapy were included. The data extraction table was designed based on specified parameters and network meta-analysis was conducted. RESULTS: Nineteen articles were included in the review, from which 14 studies were eligible for network meta-analysis. The results indicate that changes in bleeding on probing and gingival index are not significantly affected by therapeutic technique. However, clinical attachment level changes are more satisfactory in ultrasonic- and laser-treated groups 1 month postoperatively (MD = -0.3875, -0.2700 respectively). The difference from baseline is significant (p ≤ 0.0001). After 3 months, the impact of Gracey's curette on plaque index changes (p = 1.0000), as well as the effect of Erbium laser on pocket probing depth (p = 0.0069), is significantly greater than that of other instruments. CONCLUSION: The selected nonsurgical method can affect the ultimate result of periodontal therapy. For instance, clinical attachment level shows greater susceptibility to ultrasonic devices in a short-term period. Despite that, changes in bleeding on probing, gingival index, and microbiological parameters do not show significant diversity subsequent to different treatments. Taken together, clinicians can adopt a suitable method depending on their purpose, equipment, and skill. TRIAL REGISTRATION: The International Prospective Register of Systematic Reviews (PROSPERO): CRD42024544540.